Health Reform: Sputter, Sputter, Stop?

 This is a hellacious week for many folks inside the Washington Beltway: budget resolution time. On Wednesday, the House and Senate Budget Committees started marking up -- Hill-speak for editing -- the FY2010 budget resolutions.

Yesterday, the Washington Post reported that Sen. Kent Conrad (D-ND), chair of the Senate Budget Committee, "said he would leave out new spending for Obama's proposed expansion of health care coverage, a program likely to cost in excess of $1 trillion over the next 10 years, as well as the president's proposal to make permanent an $800 tax credit for working families. Lawmakers would be free to adopt those policies as long as they did not increase the deficit, Conrad said."

What does that mean exactly? Well, it means that any spending for health care reform -- for the program itself, to support workforce shortages, to improve infrastructure for health IT, etc. -- would have to be completely offset; that is, by a tax increase or spending cuts equal to the entire cost.

Now, the House is taking a different approach. They are piking the bipartisan approach and going for health reform via a budget reconciliation (BR) provision. BR was created in the 70s to rejigger spending or taxes within the budget resolution. Clinton used it in 1993 to raise fuel taxes and expand the Earned Income Tax Credit; Bush used it to pass his tax cuts in 2001 and 2003.

So why is the budget reconciliation regarded as partisan?

Well, budget reconciliation is special. These days, to pass just about anything in the Senate you need 60 "yea" votes to limit debate and actually flippin' vote on anything. But for BR, you only need a simple majority (51) and the Democrats have that, easily.

So the BR could push through health reform without triggering a filibuster. Great and wonderful right? Sadly, no.

There are a couple of big hurdles: First, only the House version of the budget resolution includes the reconciliation provision so the Senate would have to agree to that provision during conference. With Conrad opposed, and Sen. Max Baucus (D-MT) -- the guy who chairs the committee with jurisdiction over health issues -- opposed, I just don't see it. Not to mention folks on the other side of the aisle losing their minds over the prospect.

For the sake of argument, let's say that the BR survives in conference. What happens then?

Well, the House Energy and Commerce and Ways and Means Committees, and the Senate Finance Committee would craft legislation. The legislation would go back to the Budget Committee and then to the floor. House-side, this might be not a problem. But Senate-side? BIG PROBLEM.

The Senate prides itself on oddities. The rules governing its operation are arcane, weird, and downright frustrating. Among these is something called the Byrd Rule, named after Sen. Robert Byrd. The Byrd Rule forbids "extraneous" language on the budget resolution. Is extraneous defined? Of course not. For an excellent discussion of the Byrd Rule, read Ezra Klein over at American Prospect.

Is health reform extraneous? Well, it isn't strictly tax or spend so I think some members would certainly challenge it (called a point of order). The patchwork "reform" that might emerge from the other end of the sausage machine frightens me. We could end up with some provisions stricken and others not -- a disjointed mess that fails in a massive flame out like HillaryCare -- such a result would likely put off real reform for another decade or two.

Even if we manage to get cogent health reform through via the BR, it will expire in five years. Yes, you read that right. All of this blood, sweat, and tears for a five year program.

So if not the BR route, what? Well, it looks like it'll have to fully paid for via tax cuts or tax increases. The problem is that health reform -- real, honest-to-goodness health reform -- is going to cost a ton. Much of that cost will be front-loaded, meaning we'll be shelling out $$$ before we see cost savings from things like better preventative care, inefficiency of folks being treated in the ER, etc. Yes, the budget resolution allows 11 years to spread out the cost, but such projects are hard to measure -- how do you score preventative care? how do you score research?

And don't you know, we just spent a ton bailing out the banks. So there isn't anything let for health care reform. Funny how we can print money for AIG but doing the same to save lives is just too expensive.

Photo Credit: Artbymags on Flickr. Creative Commons License.

Comments

[Julie Pippert]

I truly---TRULY---believe that lack of health care reform will trigger a crisis that will make this economic crisis pale in comparison.

Our Congress is short-sighted and adhering to an agenda not in the best interest of this nation if they don't see that.